Healthcare Provider Details

I. General information

NPI: 1750577458
Provider Name (Legal Business Name): JOHN W. COOKE, D.O., P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2038 CLASSIQUE LN
TAVARES FL
32778-5787
US

IV. Provider business mailing address

2038 CLASSIQUE LN
TAVARES FL
32778-5787
US

V. Phone/Fax

Practice location:
  • Phone: 352-357-3107
  • Fax: 352-357-9971
Mailing address:
  • Phone: 352-357-3107
  • Fax: 352-357-9971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS4437
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN W COOKE
Title or Position: OWNER/PRESIDENT
Credential: DO
Phone: 352-357-3107